Ask the nursing expert: dealing with disorderly RNs

How do you manage an RN who wants to challenge—even publicly—your every decision as a DON?

Set aside some time to meet with this nurse. Send an invitation in memo form stating date, time, place and purpose of the meeting (to discuss her role as an RN on your nursing team).

Next, spend some time jotting down key points that you want to go over with her, such as: job description, expectations regarding attitude and job performance, the organizational chart of the nursing department, stressing that you are the nursing executive, your goals for the department, her strengths and areas she needs to improve in.

Ask her how she sees her role as an RN on your team, and how she might support the mission and vision of your department. This discussion should clear the air regarding her role vs. yours. Jot down some notes while you are talking to let her know that this is a serious matter. I find that keeping a “Memo for the Administrative File” helps me to remember details discussed during this type of meeting. Keep your notes in a secure place. Plan a follow-up meeting in a month or so.
Do you have any suggestions regarding how the MDS and care plan process should be done?

Have the entire team meet to discuss the facility and regulatory guidelines. It is important to have the administrator and any corporate consultants attend. Develop a structured agenda to include each step of the process and who is responsible. Allow for everyone's input, and make sure that the team agrees to the steps of the process. Meet again in about two weeks to review progress. Keeping everyone connected is key. It also is a good time to talk about the overall expectation of the team and the dangers of not working as a team.

About 60,000 elderly or disabled Medicaid recipients in Louisiana are being told they should expect to lose their benefits in July, and advocates say more than a quarter of them could be forced out of the long-term care facilities they call home.